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The following links will provide information regarding Medicare billing and reimbursement for PET procedures.
Billing and Reimbursement polices for private payers vary considerably from Medicare. Some private payers
may rely on Medicare reimbursement as the basis; many others will have exclusive guidelines to follow for
reimbursement. To obtain proper guidance on coverage polices, you should contact the payer directly or
visit their Web site. |
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| Medicare billing processess and recent changes |
| CMS-release database for retrieval of program memoranda, Provider-based entity descriptions, and start-up documentation requirements.
http://www.cms.hhs.gov/home/medicare.asp |
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| Electronic Billing and EDI Information |
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http://www.cms.hhs.gov/ElectronicBillingEDITrans/01_Overview.asp#TopOfPage |
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| National Provider Identifier Standard (NPI) |
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http://cms.hhs.gov/NationalProvidentStand/ |
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| National NPI lookup |
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https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do |
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| Hospital Outpatient Prospective Payment System (HOPPS): |
| Overview of CMS Final Rules regarding HOPPS
http://www.cms.hhs.gov/HospitalOutpatientPPS/ |
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| CMS Prospective Payment System (PPS) pricing information and calculator: |
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http://www.cms.hhs.gov/PCPricer/ |
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| Current Medicare PET and PET/CT codes: |
| CMS CR5665, current revised information on PET Scan codes and Radiopharmaceutical Diagnostic Imaging Agents Codes Applicable for PET Scan Services Performed on or After January 7, 2008 can be found at:
http://www.cms.hhs.gov/Transmittals/downloads/R1301CP.pdf
Additional information at:
http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5665.pdf
http://www.cms.hhs.gov/Transmittals/downloads/R1301CP.pdf |
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| Medicare Carriers Local coverage determination (LCD) for PET Scans by state: |
| Including additional information such as modifiers, RVUs, exclusions, limitations, contact information and fee schedules. Select state and you will be directed to the carrier’s Web site.
http://www.cms.hhs.gov/mcd/search.asp?from2=search1.asp& |
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| CMS Final National Coverage Determination (NCD) for Positron Emission Tomography (PET) Scans: |
| To view the NCD for PET scans on the CMS Web site, click on the link below:
http://www.cms.hhs.gov/mcd/viewncd.asp?ncd_id=220.6&ncd_version=3&basket=ncd%3a220%2e6%3a3%3apet+scans |
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| Medicare Claims Processing Manual, Chapter 13; Section 60 - PET Scans |
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http://www.cms.hhs.gov/manuals/downloads/clm104c13.pdf |
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| Medicare Claims Processing Manual, Transmittal 923, April 28, 2006 |
| Update of Radiopharmaceutical Imaging Agents HCPCS Codes Applicable to PET Scan Services for Carriers
http://www.cms.hhs.gov/transmittals/downloads/R923CP.pdf |
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| Part A Intermediaries and Part B Carriers by State |
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http://www.cms.hhs.gov/apps/contacts/incardir.asp? |
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| National database for UPIN lookup: |
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http://www.upinregistry.com/provider_form.asp |
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| Visit the NOPR PET Registry Web site for all forms and educational material: |
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http://www.cancerpetregistry.org/ |
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| CMS Claims processing manual for CMS approved Clinical Trial (NOPR): |
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http://www.cms.hhs.gov/Transmittals/downloads/R956CP.pdf |
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| Listing of current PET and PET/CT CPT codes: |
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Click here to download |
| PDF format/printable "Letter of Intent": |
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Click here to download |
| Payer coverage database: |
| Ongoing information on specific carriers processes for pre-certification
and coverage determinations |
| Commercial insurance directory: |
| Comprehensive listing of commercial carriers with phone numbers and
Web site addresses |
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As a service to our customers, we will do everything we can to help you with your insurance
and billing needs. These services may include: |
| • | Medicare National and local coverage determination |
| • | Scheduling process and sample forms |
| • | Reimbursement |
| • | CPT and HCPCS Codes |
| • | Billing guidelines |
| • | Covered Indications |
| • | Contracting Issues |
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If you need additional information that was not found on our Web site or have questions, please
contact us via email at the email address listed below. |
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PET Billing Administrator
Cindy Kennedy
ckennedy@rcoa.com
7900 Glades Road, Suite 400
Boca Raton, FL 33434
561-477-3500 x 369
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